CPD SPOT DIAGNOSIS ,

Self-Recorded CPD: Spot Dx – Dermatology – DER005

You can self-report this CPD/PDP activity by logging it online with the RACGP/ACRRM. The activity has been allocated 1 hour (0.5 hour EA and 0.5 hour RP). Certificates are not available for this CPD.

Test your clinical knowledge by taking the 6 quizzes below. If you select the wrong answer, have another go — you can try as many times as you like.

RACGP Activity Number: DER005

ACRRM Activity Number: DER005

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1. What brought on this crater-like lesion?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Tracey, a 55-year-old truck driver, presents with an ulcerative lesion on her right shin. She reports that she had been monitoring an enlarging, reddish brown, shiny patch on her shin for several months. More recently, she noticed it started to become yellowish and formed a crater-like lesion. She has been trying to manage the wound with products bought over the counter from her local pharmacy. Her pharmacist had a look and advised her to seek medical attention. Tracey is overweight and takes medications for hypertension and diabetes but cannot remember the names of her medications. She has no known allergies and has never had a similar lesion before. On examination, her blood pressure is normal, as is her BSL and temperature.</strong></p></p> <ul> <li>a. Granuloma annulare</li> <li>b. Erythema nodosum</li> <li>c. Varicose eczema</li> <li>d. Necrobiosis lipoidica</li> </ul> </section> <p></p>Photo: Dermnet NZ

Author

Author: Dr Paul Muthiah is a GP and a former medical co-editor of Australian Doctor.

2. What is behind this scaly rash?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>A 42-year-old woman presents with a pruritic rash over her axillae, face, trunk, back, groin and limbs. These began during her first pregnancy two years ago, starting on the axillae and spreading from there. She has trialled topical corticosteroids with only partial relief, even with high potency preparations. She now reports having difficulty sleeping due to itch. Her symptoms tend to worsen during menses. She has a history of allergic rhinitis and no known allergies. On examination, there are erythematous plaques affecting both axillae, upper limbs (pictured), groin and posterior lower limbs, as well as the face, trunk and back. The lesions have poorly defined borders and she does not think they were originally scaly.</strong></p></p> <ul> <li>a. Idiopathic guttate hypomelanosis</li> <li>b. Venous stasis dermatitis</li> <li>c. Prurigo pigmentosa</li> <li>d. Atopic dermatitis</li> </ul> </section> <p></p>Photo: Courtesy Professor Dedee Murrell

Author

Author: Professor Deedee Murrell.

3. What is behind these pungent, pitted foot lesions?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Jamie is a 15-year-old school student who presents with concerns about spreading plantar warts. The whitish pitted lesions emerged on the soles of both feet about a month ago. He self-initiated home treatment with an over-the-counter salicylic acid wart paint. He stopped this promptly as it made the lesions uncomfortable. Currently, Jamie’s main concerns are the smell and appearance of the feet; he is otherwise asymptomatic. Jamie is a competitive middle-distance runner and has noticed that his sneakers have started to get very smelly. His siblings have also started teasing him about his stinky feet.</strong></p></p> <ul> <li>a. Pitted keratolysis</li> <li>b. Plantar warts</li> <li>c. Dishydrotic eczema</li> <li>d. Tinea pedis</li> </ul> </section> <p></p>Photo: BMJ 2018; 24 May.

Author

Author: Dr Kate Kelso is a GP and medical editor at Australian Doctor.

4. What’s causing this mysterious pustular eruption?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Olivia is a 21-year-old woman who presents to ED with a two-week history of tender widespread annular erythematous plaques with peripheral pustules and scale over her trunk, arms, back and legs. She is febrile and reports associated fatigue and malaise. The lesions are tender to touch. At age 14, Olivia was diagnosed with psoriasis, which she treats with as-needed topical tar or corticosteroid preparations. Her mother also has psoriasis. Skin biopsy culture is negative for bacterial infection. Histopathology shows superficial pustules and neutrophilic infiltrate, and findings on direct immunofluorescence are unremarkable.</strong></p></p> <ul> <li>a. IgA pemphigus</li> <li>b. Acute generalised exanthematous pustulosis</li> <li>c. Bacterial infection complicating plaque psoriasis</li> <li>d. Generalised annular pustular psoriasis</li> </ul> </section> <p></p>Photo: Courtesy Professor Dedee Murrell

Author

Author: Professor Deedee Murrell.

5. Can you lick the case of this perioral rash?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Olivia, aged 10, attends with her parents for follow-up of tinea pedis, which developed after a recent school camp. The foot rash has resolved, but a new perioral erythematous rash has now appeared. Olivia has been compliant with topical antifungals, diligent with foot care and taking daily showers. She uses a low-irritant body wash and moisturiser, daily SPF 50+ sunscreen for sensitive skin and has recently started using a regular pawpaw ointment for chapped lips. She is otherwise well, has no past history of note and no known allergies. On examination, the only findings are patches of blanching perioral erythema, with no clear border or associated scale (pictured). There is no facial oedema, and the feet examine normally.</strong></p></p> <ul> <li>a. Allergic contact dermatitis</li> <li>b. Tinea faciei</li> <li>c. Vitamin B12 deficiency</li> <li>c. Rosacea</li> </ul> </section> <p></p>Photo: Courtesy Professor Dedee Murrell

Author

Author: Professor Deedee Murrell.

6. Do these annular lesions ring a bell?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Sandra is a 35-year-old HR consultant who presents with a 48-hour history of a rash on the lower legs and thighs. Initially, she thought she had hives, with wheals covering the affected areas. But over the past 24 hours, they have evolved to the annular lesions pictured, including symmetrical rings of ecchymoses. The rash is not itchy, but there is localised tingling. There are no associated systemic symptoms. Sandra is generally well, with no medical history of note, no known allergies and no regular medications. She is up to date with COVID-19 and seasonal influenza vaccinations. Blood tests — including ESR, autoimmune panel, FBC, complement and cryoglobulin — are normal.</strong></p></p> <ul> <li>a. COVID-19</li> <li>b. Idiopathic urticarial vasculitis</li> <li>c. SLE</li> <li>d. Chronic idiopathic urticaria</li> </ul> </section> <p></p>Photo: BMJ 2021

Author

Author: Dr Kate Kelso is a GP and medical editor at Australian Doctor.

References on request from kate.kelso@adg.com.au